A single-stage operation in the treatment of tibial chronic osteomyelitis with the use of the Ilizarov technique | ||||
| The Egyptian Orthopaedic Journal | ||||
| Volume 47, Issue 3, September 2012, Page 296-304 PDF (995.3 K) | ||||
| DOI: 10.7123/01.EOJ.0000417995.30471.20 | ||||
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| Author | ||||
| El-Hussein M. El-Moatassem | ||||
| Abstract | ||||
| Background Treatment of chronic osteomyelitis of the lower extremity presents one of the most difficult challenges for a reconstructive surgeon. Appropriate radical debridement requires excision of all necrotic bone and soft tissue, which often results in a large bone defect. The unstable situation requires some type of fixation and reconstruction of the resultant bone and soft-tissue defects. The aim of this study was to summarize my experience with distraction osteogenesis performed using an Ilizarov fixator for the treatment of tibial bone defects and limb shortening resulting from radical debridement of chronic osteomyelitis. Materials and methods Sixteen patients ranging in age from 9 to 55 years underwent radical debridement for the treatment of chronic osteomyelitis of the tibia. The lesions were classified, according to the Cierny–Mader classification system, as type IVA (12 cases) and type IVB (four cases). The resulting segmental defects and any limb-length discrepancy were then reconstructed by distraction osteogenesis using the Ilizarov technique. In all patients infection was eradicated, except four, who required a second procedure. At the time of the last follow-up, functional and radiographic results were evaluated using the criteria of Paley and colleagues. Results The mean size of the defect was 5.25 cm (range 3–8 cm) in the tibia. The mean external fixator index was 43.8 days/cm (range 33.7–60 days/cm). The mean total duration of external fixation was 7.5 months (range 4–11 months). At a mean follow-up of 21.9 months (range 6–38 months), 11 of the 13 patients showed excellent bone results and the functional assessment of nine patients indicated excellent results. There were four recurrences of infection that required a second procedure for all of the four patients; subsequently, the infection was controlled and the bone was consolidated. Conclusion The clinical experience with the 16 patients showed that this one-stage surgical procedure with a short duration of hospital stay and excellent long-term results seems to be a promising strategy for the definite treatment of chronic osteomyelitis. All well-known disadvantages of a multistage approach, such as repeated operations, prolonged morbidity with the many ensuing psychological changes, and increasing medical costs, can be avoided by using the described method of a single-stage operation, which leads to rapid rehabilitation and recovery in addition to increased quality of life and decreased medical costs. | ||||
| Keywords | ||||
| Ilizarov Technique; Osteomyelitis; tibial chronic | ||||
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